APEA 3P Exam – Complete Practice Exam (160 Questions) 2026|2027 MUST KNOW QUESTIONS

APEA 3P Exam – Complete Practice Exam (160

Questions) 2026|2027 MUST KNOW QUESTIONS

Instructions

 Each question has one correct Correct Answer.

 Rationales are provided after each Correct Answer.




Section 1: Cardiology (Questions 1–20)

1. A 58-year-old male with hypertension presents with acute onset of tearing chest pain radiating to
the back. BP is 160/100 in right arm, 100/70 in left arm. What is the most likely diagnosis?

 A) Acute myocardial infarction

 B) Pulmonary embolism

 C) Aortic dissection

 D) Pericarditis

Correct Answer: C) Aortic dissection
Rationale: Tearing chest pain radiating to back with unequal BP in arms is classic for aortic dissection. MI
pain is typically crushing/substernal. PE causes dyspnea/pleuritic pain. Pericarditis pain is positional.




2. Which antihypertensive is contraindicated in pregnancy?

 A) Methyldopa

 B) Labetalol

 C) Nifedipine

 D) Lisinopril

,Correct Answer: D) Lisinopril
Rationale: ACE inhibitors (lisinopril) and ARBs are teratogenic (fetal renal agenesis). Methyldopa,
labetalol, nifedipine are safe in pregnancy.




3. A 72-year-old with HFrEF (EF 30%) presents with worsening dyspnea, JVD, and peripheral edema. Cr
1.8 (baseline 1.0). Which medication should be held?

 A) Furosemide

 B) Metoprolol succinate

 C) Spironolactone

 D) Hydralazine

Correct Answer: C) Spironolactone
Rationale: Spironolactone can cause life-threatening hyperkalemia, especially with AKI (Cr rise). Hold
until renal function improves. Beta-blockers continue cautiously.




4. First-line therapy for stable angina in a patient with known CAD is:

 A) Nitroglycerin PRN

 B) Aspirin + beta-blocker

 C) Calcium channel blocker

 D) Ranolazine

Correct Answer: B) Aspirin + beta-blocker
*Rationale: Beta-blockers reduce myocardial O2 demand; aspirin prevents thrombotic events.
Nitroglycerin is symptomatic relief only. CCBs are second-line.*




5. A heart murmur is heard best at the apex with the bell, radiating to axilla. It is holosystolic. Most
likely:

,  A) Aortic stenosis

 B) Mitral regurgitation

 C) Mitral stenosis

 D) Aortic regurgitation

Correct Answer: B) Mitral regurgitation
*Rationale: Holosystolic, apical murmur radiating to axilla = MR. Aortic stenosis is systolic at 2nd RICS
radiating to carotids. Mitral stenosis is diastolic. Aortic regurgitation is diastolic.*




6. Which ECG finding is most specific for pericarditis?

 A) ST elevation in V1–V4

 B) Diffuse PR depression

 C) Q waves

 D) T wave inversion

Correct Answer: B) Diffuse PR depression
Rationale: PR depression (or PR elevation in aVR) is early and specific for pericarditis. Diffuse ST elevation
is also seen but less specific. Q waves = prior MI.




7. A 45-year-old with palpitations has an irregularly irregular rhythm on ECG with no visible P waves.
Rate 140. Next step?

 A) Adenosine IV push

 B) Amiodarone

 C) Rate control with metoprolol

 D) Immediate cardioversion

, Correct Answer: C) Rate control with metoprolol
Rationale: Atrial fibrillation with rapid ventricular response. Stable → rate control. Adenosine is for SVT.
Cardioversion if unstable.




8. Which statin is preferred for drug-drug interaction concerns (e.g., with amiodarone)?

 A) Atorvastatin

 B) Simvastatin

 C) Pravastatin

 D) Rosuvastatin

Correct Answer: C) Pravastatin
Rationale: Pravastatin is not metabolized by CYP3A4 (unlike atorvastatin, simvastatin), so fewer
interactions. Rosuvastatin has minimal but not zero interaction.




9. A patient with CHF reports dry cough and angioedema after starting a new med. Which drug?

 A) Losartan

 B) Lisinopril

 C) Metoprolol

 D) Hydrochlorothiazide

Correct Answer: B) Lisinopril
Rationale: ACE inhibitors cause dry cough (bradykinin) and angioedema. ARBs (losartan) have lower risk
but can still cause angioedema rarely.




10. What is the target LDL for a diabetic patient with known CAD?

 A) <100 mg/dL